 I had a patient come in that was 79 years old and he was unfortunately riddled with lung cancer. I mean it was in every bone in his body, he had lost about 40 pounds and I told him it was a kind of a do or die circumstance. I was like I'm gonna put, I have to use multiple chemo's because if we don't reduce this immediately you're gonna pass away and unfortunately I don't even know if like the way you know the presentation is if we can even have long enough for the chemo to work. Put the port in, had him come in, but I ordered NGS meaning next generation sequencing or profiling on the tumor hoping that there was an actionable or targeted mutation. He comes in for his chemotherapy, port ready, chemo ready and the results said he is positive for EGFR. I was so excited when I talked to them they both around 80 years old and you know kind of rural Louisiana started crying with happiness just appreciating feeling the joy that I had about this mutation. We started an oral pill attacking that mutation, did not need chemotherapy and oftentimes the pill maybe has like a rash or some maybe indigestion. We re-imaged everything in about six to eight weeks and there was no detectable disease anywhere and this is not a miracle story. This is what actionable targeted mutations are unlike chemo which is a general approach you're actually trying to attack the Achilles heel of the tumor and we have a lot of those and a lot of different cancer types which is why profiling is so important. Another example which illustrates two things that are really cool about what cancer treatments are like today. There was a patient that was 92 years old in the ICU found to have multiple lung spots that were cancer as well as in her bones as well as in her brain and of course the family said she's 92 years old, she's been an amazing mother and grandmother. We don't even want to risk the biopsy because the lung could puncture which was reasonable. So I said this looks very suspicious for lung cancer, you're a non-smoker which by the way non-smokers can definitely get lung cancer 10% or so so please don't think that that's impossible but it seems like you're a non-smoker that has lung cancer. Let me just do a blood draw just like a CBC a blood count or chemistry's kidney function. That test came back positive for again EGFR mutation. We didn't biopsy or go do an invasive procedure. We started an oral pill and it took away the disease throughout her body and her brain for literally 18 months, enabled her to travel the entire world with her husband, enjoy her family time, never took a needle stick beyond a blood draw and it was all because of the actual mutation. Both of these cases the 79 year old and the 92 year old give you an idea of the power of targeted therapy. The next step in medicine is to say okay this is fantastic it can work for a year to two years but then it stops working. Why? Well those are called escape mechanisms and EGFR we know eventually finds an escape mechanism to says I can finally survive as a cancer outside of that mutation being targeted. Today we are looking at therapies and medications that can now attack people that have progressed on that EGFR directed therapy and not have to go straight to chemo like I've done in my 80 year old who is still alive two years later and doing well. So chemo therapy definitely works but to explore these options not only do you have to get that tumor profiling or next generation sequencing it also underscores the importance of re biopsy to see what are the new targeted mutations. These escape mechanisms came out under selection pressure of the therapy to say I got to find a way out. I got to find a way out to survive this. It won't be present on your first testing where it showed you what the mutations were. So when you re biopsy it either through blood or through tissue that's what tells you what are the next steps for another actionable mutation that I can target. If you find stuff like this important or educational or interesting or especially if you are the loved one is battling cancer and having to have this journey please subscribe to this channel because we want to empower you with this kind of information so that you can have the most up to date options and really just take the most optimal care of you or your loved one.